Individual
SR EVANS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1604 LEFLORE AVE, GREENWOOD, MS 38930
(662) 453-0532
(662) 453-3079
Mailing address
1604 LEFLORE AVE, GREENWOOD, MS 38930
(662) 453-0532
(662) 453-3079
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
04978
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00125971
—
MS
01
—
020052768
RAILROAD MEDICARE
MS
Enumeration date
10/20/2006
Last updated
04/30/2008
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